Paul Bradford (Fine Gael)

Former Taoiseach, Charles Haughey, used the phrase when he led Fianna Fáil to election success in 1987 but, within months, he embarked on the most extensive slashing of health expenditure, hospital beds and health services in the history of the State. It is fair to state that we have not yet recovered from the cuts made in 1987 and the amazing policy of removing hospital beds and increasing waiting lists. We must ask ourselves whether this Health Bill will, at least, return the services and beds which existed in 1987 or increase them beyond that level. I have doubts that it will do so.

I was happy when the Tánaiste was appointed as Minister for Health and Children because she genuinely views the job as a challenge and genuinely believes progress can be achieved. However, we must be careful about where the starting point is. We spend a great deal of money on health in Ireland but, by European standards, we are very much mid-division. We cannot claim to spend the highest proportion per capita on health services in Europe. However, we spend billions of euro on health and we must ask ourselves if we are obtaining value for money which, I suspect, we are not.

Senator Glynn referred to orthodontics and indicated that, in his region of the country, tremendous progress has been made, which I am glad to hear. However, I recall a number of discussions on the Joint Committee on Health and Children in which orthodontics was the subject of serious debate. It appears to me that orthodontic services throughout the country are in crisis, certainly in the Southern Health Board region. As the Minister of State will know from parliamentary questions, there is an almost endless waiting list. When the parent of a nine, ten or 11 year old child comes to a clinic to inform one that he or she must wait three, four or five years to have his or her child seen treated by an orthodontist, one must ask if that is the type of modern health service of which we proclaim to be so proud.

We are duty bound on this side of the House to recognise achievements where they are made and acknowledge their results. To that end, I acknowledge that the national treatment purchase fund has been very successful. In that context, will the Minister of State discuss with the Tánaiste the possibility of extending the treatment purchase fund to the orthodontic sector? It is not good enough to tell a young teenager that the importance of his or her need for orthodontic treatment is recognised but that it will not be undertaken for three or four years. The extension of the treatment purchase fund to clear the waiting list for orthodontic treatment would allow us to start anew and I ask the Minister of State to consider the suggestion.

This Bill is wide-ranging because it deals with the reform of the structures, with which I have no difficulty as I believe they need to be radically reformed. However, although the Bill has not been introduced without being well-flagged in advance, the almost mad rush to process the Bill in a short space of time might not be the wisest way to go about our business. The Bill contains significant changes in how we do our business on the health front. However, much more dialogue and debate is required.

As the Minister of State knows well, we do not need more reports. The previous Minister for Health and Children must have been the champion of reports because, for every problem in the health service, he commissioned a report and for every report which was published, there was another report on it. There was a great deal of talk, paper and consultation with consultants but we did not see results. I want to see results from this process. I want to see the Bill resulting in the citizens receiving the quality and quantity of health care they deserve. That this Bill is our starting point demonstrates how badly we have managed the health service. It should be possible for the money we spend to give people a quality health service. I advocate an increase in the expenditure but we should not have waiting lists of many years for elective and other surgery given the billion of euro we spend each year. This issue must form the starting point for the debate as far as patients are concerned.

From the point of view of the patients and consumers for whom this Bill is intended, it is not a question of ideology or philosophy. The outgoing Chinese premier made the point that it did not matter if a cat was black or white as long as it caught the mouse. Irish patients are not worried about the philosophy or ideology of the health care service or whether the provider is public or private or a combination of both; they want a service delivered. That is the debate we need to have but I wonder if we are considering it. The Minister referred to structural reform in her speech but the Bill appears cumbersome and I wonder how quickly it can be implemented and how truly radical it will be.

A member of the Progressive Democrats once referred to a need to be "radical or redundant". In that context, we need to be radical about the health service. We need to work more closely with the people working in the service and not rush the Bill as much. In her speech, the Minister outlined the details of the national health consultative forum, the regional health forums, the advisory panels and the statutory complaints framework, all of which are valid. However, what we have not heard from the Minister with great certainty or definition is that, when enacted, this legislation will mean a better, more accessible service for the patient. We all face that challenge when debating health legislation in this House and that is what we want to see emerge. I am disappointed that we are rushing this legislation through on a Friday evening as if the world will change on 1 January 2005. I do not think it will but I wish the Minister well in her endeavours. If she takes on board what the Opposition is saying, we could all work together to improve the service. Patients want action rather than words.